Dr. Shishir Lakhey
Dr. Mike Mansfield
BACKGROUND
- 90% of patients do well conservatively
- A variety of surgical procedures
- Tenotomy of the common extensor origin
- Most common used surgical procedure historically
- Excision at ECRB
- Denervation of the lateral epicondyle
- Decompression of the radial nerve
- Division of the annular ligament
- Excision of intra-articular synovial folds
- Surgical lengthening of the ECRB tendon
AIM AND OBJETIVE
Effectiveness of Percutaneous tenotomy using the bevel of an 18G hypodermic needle
MATERIALS AND METHODS
17 Patients – 21 Elbows
Age: 36-64 (48.3)
Pain duration: 2 months – 7 years (14.9m)
0-6 steroids injects. (2.9)
- Retrospective study
- Data collected from patient’s medical records
- Follow up – by questionnaire mailed to the patient’s home
- Follow up – 4 months to 6 years (2.5 year)
TECHNIQUE
- Position – Forearm on table
- Elbow flexted to 90 / Wrist to 60
- Part Prepn. And local anesthetic
- Percutaneous introduction of needle
- Tenotomy
- Puncture site sealed
- Wrist brace
- Tab. Paracetamol post op.
OUTCOME CRITERIA
Excellent: Full return to all activity with no pain
Good: Full return to all activity with occasional pain
Fair: No pain with normal activity, significant pain with heavy activity
Poor: Little or no relief of pre-operative symptoms
RESULTS
PT OUTCOME ASSESSMENT |
No. OF ELBOWS |
PERCENTAJE |
| Excellent | 9 |
(42.9%) |
| Good | 7 |
(33.3%) |
| Satisfactory | 4 |
(19%) |
| Poor | 1 |
(4.8%) |
- No complications
- Time taken: 1 day to 3 months (average 60.3 days)
- Residual pain: 1.5 to 8.5 on the VAS (average 2.64)
AETIOLOGY (Discussion)
- Bursitis
- Periostitis
- Infection
- Aseptic necrosis
- Neuritis of branches of the radial nerve
- Radiohumeral synovitis
- Irritation of the collateral ligament
- Most widely held theory is that are macroscopic or microscopic tears in the common extensor origin
- Including multiple steroid injections – affect microscopic changes
- No published studies have examined specimens from patients with acute tennis elbow
- Most plausible is chronic inflamatory response to microtrauma in avascular tendon environment
- Solution is to convert chronic inflamatory lesion to acute injury and because of incresed vascularity result in rapid healing
SURGICAL OPTIONS (Discussion)
- Excision at ECRB
- Denervation of the later epicondyle
- Decompression of the radial nerve
- Division of the annular ligament
- Excision of intra-articular synovial folds
- Surgical lengthening of the ECRB tendon
- Percutaneous vs open
- No 11 or 15 Surgical knife
* Quicker
* Simpler
* Minimum morbidity
* Good to excellent results in majority
(Grundberg AB, Dobson JF)
(Yerger B, Turner T)
(Baumgard SH, Schwartz DR)
(Dunkow PD et al.0)
RESULTS OF OTHER PERCUTANEOUS TECHNIQUE STUDIES
- Grundberg AB, Dobson JF:
29/32 excellent/good, no criteria
- Yerger B, Turner T:
149 Patients, 90% excellent/good, no criteria
- Baumgard SH, Schwartz DR:
32/35 excellent, excellent – No symptoms, Fair – Improvement, Poor – No Improvement
OUTCOME CRITERIA
Excellent: Full return to all activity with no pain
Good: Full Return to all activity with occasional mild pain
Fair: No pain with normal activities. Significant pain with heavy activities
Poor: Little or no relief of pre-operative symptoms
Our results: 76.2% Excellent/Good
Only 1/21 Failure to improve = 95% improved
OUTCOME CRITERIA
- Percutaneous Tenotomy using an 18 gauge hypodermic needle is a simple, safe, patient friendly, effective and easily reproducible OPD method.
- Degenerative tear of common extensor origin.